MEDICARE: RACHEL KOESTER IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)

General Provider Information

NPI Number	:	1235968397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL KOESTER IBCLC

Provider Business Mailing Address
First Line	:	4000 HARTFORD ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-3929
Country	:	US
Telephone Number	:	618-977-6904
Fax Number	:

Provider Business Practice Location Address
First Line	:	11777 GRAVOIS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1822
Country	:	US
Telephone Number	:	314-252-0153
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2024
Last Update Date	:	07/29/2024

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